| NPI | 1780952812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27047) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014353) |
| Enumeration Date | 2011-12-04 |
| Last Update Date | 2019-10-22 |